Fungal, Tropical, and Animal-Borne Diseases Flashcards
This spore is more common in hot, dry areas such as the desert; sometimes called ‘valley fever’. Patient would usually complain of joint pain (desert rheumatism) and presence of eythema nodosum. What is the most likely diagnosis?
Coccidiomycosis
What is the most accurate test for Coccidiomycosis?
Sputum culture, serology
How would you treat Coccidiomycosis?
Moderate disease: Fluconazole or Itraconazole
Severe disease: Amphotericin
This is a fungus found in moist soil containing bird and bat feces (e.g., caves, river valleys), It resemble TB with lung cavities. It also involves bone marrow (pancytopenia) as well as the spleen and lymph nodes.
Histoplasmosis
What is the most accurate test for Histoplasmosis?
Sputum culture, blood, or affected organs
How would you treat Histoplasmosis?
Amphotericin followed by Itraconazole for severe illness
This fungus is found in soil and rotten wood near water. It involves the lungs, bone, skin, and prostate. Smear reveals a ‘broad budding yeast’. What is the most likely diagnosis?
Blastomycosis
What is the definitive test for Blastomycosis?
Culture
How would you treat Blastomycosis?
Itraconazole
This mold occurs exclusively in immunocompromised patients, especially diabetics in DKA. It rapidly dissects the nasal canals and eyes through to the brain. Mortality is very high and this is a SURGICAL EMERGENCY. What is the diagnosis?
Mucormycosis (Zygomycosis)
What drug increases the risk of Mucormycosis?
Deferoxamine (mobilizes iron)
What is the best initial therapy for Mucormycosis?
Amphotericin
How do you diagnose Mucormycosis?
Biopsy
How do you diagnoses Invasive Aspergillosis?
Lung Biopsy
What is the best initial test for Invasive Aspergillosis?
Voriconazole, Isavuconazole, or Caspofungin
DO NOT answer Amphotericin
How do you diagnose Malaria?
Thick smear for detection
Thin smear for speciation
How do you treat mild-moderate Malaria with Plasmodium Falciparum infection?
Mefloquine or
Atovaquone/Proguanil
How do you treat mild-moderate Malaria with Non-Falciparum infection?
Chloroquine
Primaquine (vivax or ovale only)
How would you clasify parasetemia of >5%, CNS abnormalities (confusion, seizure, coma), Hypotension/shock, or pulmonary edema, renal injury, acidosis, or hypoglycemia in a patient with Malaria?
SEVERE Malaria
How do you treat severe Malaria?
Artemisinins (Artemether, Artesunate)
A patient is about to go to a malaria endemic area. What should you give for prophylaxis?
Mefloquine or
Atovaquone/proguanil
If a patient has malaria with history of neuropsychiatric illness, what medication shall you AVOID giving?
Mefloquine
This disease is transmitted by Aedes mosquito. It is caused by a single-stranded RNA of African origin. It is characterized by intense joint pain that may persist for months, periarticular edema, and rash (<50% of cases).
Chikungunya
This disease is transmitted by Aedes mosquito. It is characterized by bone pain, and the second episode is worse. It causes severe thrombocytopenia that can lead to petechiae and GI bleeding with sometimes fatal hemorrhage and shock.
Dengue
What would you look for in Dengue Fever?
low WBC count and high transaminases
This disease is transmitted by Aedes mosquito. This is the most dangerous in pregnancy because it causes microcephaly. It is also associated with Guillain-Barre.
Zika Virus
What are the common symptoms of Chikungunya, Dengue, Zika, and Ebola?
Fever, Headache, Malaise
How would you detect Chikungunya, Dengue, Zika, and Ebola Viruses?
ELISA or PCR
This disease presents as nonspecific viral syndrome followed by severe GI distress, with high-volume diarrhea. It is transmitted only by direct contact with body fluids from a person in whom symptoms are present. Encephalitis can develop.
Ebola Virus
This organism is a gram-positive, spore-forming bacterium that occurs in sheep, cattle, horses, and goats.
Bacillus antracis
This is a type of anthrax that is characterized by a painless black eschar at site of contact. It is often self-limited.
Cutaneous anthrax
This is a type of anthrax that occurs as an ulcerative lesion that produces abdominal pain, vomiting, and diarrhea. The lesion may perforate.
Gastrointestinal anthrax
This is a type of anthrax that can be rapidly fatal. There is widened mediastinum on X-Ray, hemorrhagic lymphadenitis, and pleural effusion.
Inhalation anthrax
How do you diagnose Anthrax?
Culture that shows boxcar-shaped, encapsulated rods
Treatment of choice for Anthrax.
Quinolone or Doxycycline
It is a protozoan, originally from cattle and transmitted by ticks. It infects red blood cells, causing hemolysis. It is is life-threatening in asplenic patients.
Babesiosis
What is the best initial test for Babesiosis?
Blood smear showing red cell inclusions
How would you treat Babesiosis?
Azithromycin and Atovaquone
This is ‘cat-scratch disease’, that produces enlarged and tender regional lymph nodes.
Bartonellosis
How would you treat patients with Bartonellosis that has hepatosplenic involvement or neuroretinitis?
doxycycline or azithromycin and rifampicin.
This infection may present as fever for weeks/months, hepatosplenomegaly, endocarditis, osteomyelitis, meningitis, or chronic joint pain. + History to unpasteurized milk or uninspected meat; a returning war veteran
Brucellosis
How would you diagnose Brucellosis?
Blood culture, CSF, urine, marrow
How would you treat Brucellosis?
Doxycycline and Gentamicin
Add rifampicin for bone and heart infection
This infection usually come from dogs and sheep who shed the eggs and ingested by humans. It spreads to liver, lung, and brain forming hydatid cysts.
Echinococcosis
How do you diagnose Echinococcosis?
detect cysts with sonogram, CT, or MRI; confirm with ELISA
How do you treat Echinococcosis?
DO NOT aspirate cysts
Oral albendazole, injection of alcohol into the cysts
This infection presents with fever, headache, malaise, and chills. These are obligate intracellular parasites similar to Rickettsia. They are transmitted from the bite of the Ixodes scapularis tick, just like Lyme and Babesia.
Ehrlichiosis and Anaplasmosis
This infection usually occurs by ingestion of food contaminated with the urine of an infected animal, usually a rat. The kidneys (oliguria) and liver are affected, and possibly the CNS as well. Patient presents with muscle pain and CK elevation.
Leptospirosis
How would you diagnose Leptospirosis?
ELISA
How would you treat Leptospirosis?
Amoxicillin, Ceftriaxone, or Doxycycline
This is a protozoan spread by Sandflies. It has two froms: skin/mucosal, and visceral (liver and spleen involvement with fever)
Leishmaniasis
What is the diagnostic test for Leishmaniasis?
Direct visualization on aspirates of liver, spleen, or marrow or in white cells
What is a confirmatory test for Leishmaniasis?
PCR and culture
How would you treat Leishmaniasis?
Liposomal amphotericin, Miltefosine, or Antimonials (Stibogluconate)
Miltefosine for cutaneous, mucosal, and visceral leishmaniasis
What is the best initial test for Yersinia Pestis infection (Plague)?
smear of node aspirate showing gram-negative rods
What is the most accurate test for Yersinia Pestis infection (Plague)?
Culture
How would you treat Yersinia Pestis infection?
Streptomycin, Gentamicin, or Doxycycline
This infection can be transmitted by contact with infected rabbits, muskrats, and prairie dogs, and bites from ticks or flies. The patient presents with skin ulcers, glandular enlargement, and/or conjunctivitis from a tick bite. Inhalation of spores causes rapidly fatal pneumonia.
Tularemia
How would you diagnose Tularemia?
Serology
How would you treat Tularemia?
Streptomycin, Gentamicin, or Doxycycline
